Richard M. Pearce

“ This phase of medicine, the development of instruments and means of studying diseases of the internal organs and the organs of the special senses—the history of the stethoscope, the ophthalmoscope, the laryngoscope, and like instruments—is a most fascinating subject and one worthy of extended treatment, but it must suffice here to state that the new methods of direct exploration brought about a complete revolution in the knowledge of disease and had "more influence on the development of modern medicine than all the 'systems' evolved by the most brilliant intellects of the eighteenth century." ”

“ At the time, the activities of these men were not seen to be directly contributory to the science and practise of medicine, but as the years went on and it became more and more evident—largely as the result of their work—that knowledge was to be gained not by establishing all-embracing systems of philosophy, but by the accumulation of facts through exact observation and experiment, their methods became the property of all branches of science and so, naturally, of medicine. ”

“ Thus we find the stage set for Vesalius and Paré, who with Hunter, though he entered somewhat later, laid the foundation, which, when anesthesia and antisepsis were added in the nineteenth century, gave surgery its right to claim a scientific basis. Vesalius, occupying a chair of surgery at Padua, developed anatomy as an exact observational science; indeed he may be considered as the founder of modern anatomical research. This was his great work; this and his influence in weakening the old speculative medicine and in establishing the principles of the scientific method. ”

“ We therefore enter the sixteenth century of the christian era with little or nothing added during 2,000 years to Hippocrates's methods of exact observation in clinical medicine and surgery, with no decisive contribution to anatomy or experimental physiology for 1,300 years and with the beginnings of chemistry as applied to medicine and pharmacy removed by 600 years.
But despite this absence of real progress, a thin thread of learning and practise connected the medicine of Galen with the dawn of science in the middle ages. ”

“ The part of physics in medicine from Galileo to Roentgen is one of the most fascinating phases of the history of medicine; in principle and practise, in theory and science, its influence has been one of fundamental importance and in its application to methods of clinical diagnosis it shares equally with pathological anatomy in the awakening of modern clinical medicine. ”

“ The advance in these general subjects it is my intention to follow along the lines of physics, chemistry and biology, as they developed in France, England and Germany. And, if in the course of this presentation I have much to say about the work shops of these sciences, it is because universities, laboratories and hospitals, as. well as societies and journals, represent the visible machinery of nineteenth century research in medicine, and whether we regard them as the cause or the effect of the awakening of 70 years ago, they to-day constitute our hope for the future of medical research. ”

“ My education fell within a period of the development of modern medicine when among thinking and conscientious minds there reigned perfect despair. It was not difficult to understand that the older and mostly theorizing methods of treating medical subjects had become absolutely useless. . . . We can not wonder if many honest, serious thinking men turned away in dissatisfaction from medicine, or if they from principle embraced an extreme empiricism. ”

“ But as Neuburger states in his discussion of early medical theories, "Collection and observation of facts constitute the first step in science, but not science itself." The observation of anatomical facts during these centuries is naturally of some importance in connection with the growth of anatomy, but unfortunately of no importance as regards the influence of those facts on medical theory, for physiology remained a field for speculation while the facts gained from anatomy were used only to strengthen the older speculation and dogmatism, and to rehabilitate discarded doctrines. ”

“ Vesalius was reviled and forced to leave Padua, Hunter's ligation of a vessel in continuity was at first ridiculed and Harvey's discovery, like others in various fields, because not possible at once of practical application, did not appeal to medical men-who still clung to the traditional teachings of Galen. It was the period of genius working alone without the approval of the profession, without the support of universities and laboratories, and without the means of publications and the means of travel that to-day render almost immediately available new advances, achievements and theories. ”

“ Next in order of development comes that science which is concerned with the study of disease, pathology and upon which are based sound diagnosis and rational therapy and for this reason the science of most interest in medicine. Pathology owes its position as a recognized science to the genius of Virchow, but, in its development, it also owes much to the period I have just discussed, as I will show in due time. ”

“ The political world survived the invasion of the barbarians, but the intellectual world was dying of dogma. For hundreds of years it was "first the soldier; second the priest; third the lawyer; fourth the merchant; fifth the physician; and then after a long interval the surgeon, ranking with the humblest of craftsmen." (Mumford.)
Nearly fourteen centuries pass after Galen before we can again take up the thread of progress. In these centuries—lost to science generally—the history of medicine shows but one isolated period of effort worthy of mention. ”

“ I have lived under the eyes of and contemporaneously with great men and during the development of modern medicine. . . not as a cooperator, it is true, but as an interested looker-on, when great things happened.
Aside from Vienna, where Rokitansky taught, there were
only two places in all Germany in which pathological anatomy could be learned. One of them was Würzburg, there was Virchow, the other was Göttingen, there was Frerichs. So to Göttingen I went in search of pathological anatomy. . . . ”

“ The medicine associated with the revival of learning had its beginnings in the translation of Greek treatises on medicine through the Arabic; and in the early universities, especially those of Padua and Bologna and this revival of the exact methods of Hippocrates and Galen, gave to medicine a basis more substantial than the traditions of monastic medicine which had been perpetuated through ten centuries, and upon which were founded those widely scattered, but epoch-making advances which medicine reckons as its share in the general revival of literature, art and the sciences. ”

“ To-day we are interested above all other things in the chemistry of the cell, but from the time of Schwann to the time of Pasteur the study of the morphology of the cell in health and in disease was one of the chief interests of scientific medicine. ”

“ It is one of those problems which still remain for historians to solve—how the race ever survived the insanitary conditions of the Middle Ages, and still more how it was ever continued—what was the normal death-rate and the normal birth-rate of cities? The towns were no doubt maintained by immigration, and the rural labourer had the best chance of life, if he could manage to escape death by violence or famine. ”

“ It would be comparatively simple to chronicle the advance in any one field, as, for example, surgery, pathology or therapy; but this would, I fear, be less interesting and certainly not enlightening as to the full influence of research. The advantages to the community resulting from research in medicine are advantages because re"search has done away with conditions which were disadvantageous to the health, the happiness and prosperity of the community—in short such research has removed the impediments to a higher, happier and more prosperous civilization. ”

“ Bernard has the distinction of being the first man of science to whom France accorded a public funeral, a recognition not alone of personal worth, but also of the nation's debt to science and to research in the field of medicine. ”

“ It is difficult for the student of to-day, thoroughly drilled concerning the details of cell structure in his courses in normal and pathological histology, to realize that only a little over 70 years ago the essential feature of the animal cell, the nucleus, was not recognized, and that it was a botanist who first brought the subject to the attention of a physiologist. Medicine in all its phases has advanced rapidly along the path thus opened up by Schleiden and Schwann. ”

“ Indeed there is much ground for the belief that much of our modern hygiene can be traced back through Greek and Hebrew to the pioneer work of the ancient Egyptians.
Persian medicine is of little moment and differs but slightly from that of other ancient peoples in its religious-hygienic measures. One phase of religious belief was disastrous for the development of even simple empiricism—the belief that the dead and the diseased were unclean. Such a view naturally made impossible the study of anatomy and diagnosis. ”

“ Galen is the link between Hippocrates and Alexandrian anatomy, on the one hand, and Vesalius and Harvey, on the other.
With his death and the passing of his immediate successors progress languished and expired, for the ancient world was dying and was bearing down with it the humaner arts. . . . For generations it seemed that the church alone had survived. . . cherishing ignorantly often, but jealously and fiercely, the records of a past science. ”

“ Experimental physiology, except as Haller and Hunter had influenced it, was an unknown field, soon, however, to be widely explored as the result of the introduction of instruments of precision and analytical methods. Pathology, dependent upon the methods of histology and physiology was marking time, and, in turn, internal medicine awaited the development of pathological anatomy. Surgery, slowly improving technical procedures, likewise marked time until anesthesia and asepsis opened new worlds to it. ”

“ The fourth lecture will be a survey of present-day methods and problems, and the fifth lecture will be a discussion of the position of medical research in America, its facilities, needs and opportunities, with special reference to medical research as a function of the university.
Of medicine in the earliest stages of its development we have no knowledge. Not until we arrive at a period of civilization as highly developed as that of the Assyrians and Egyptians do we find references to the practise—the studied practise—of medicine as a healing art. ”

“ Between Morgagni, Bichat and Virchow we have an interesting link, that formed by the successive theories which placed disease in the organs, the tissues and the cell, respectively. Rokitansky worked with the organs and tissue and had no influence in carrying the quest on to the cell. The influences which led Virchow to the latter are wholly those we have discussed in the story of physiology and its beginnings, the personal influence of Johannes Müller, Schwann's writings and the results of the application to medicine of the methods of physics and chemistry. ”

“ It is not to be supposed, however, that Schwann had the conception of the cell which we have to-day. He, as Schleiden before him, made faulty observations and drew faulty conclusions. The important features of Schwann's work were the recognition of the nucleus, not the cell wall, as the important part of the cell, the demonstration of the union or grouping of the cells to form tissues, [2] and the demonstration that the distinctive cells of the tissues of the adult develop from the undifferentiated cells of the early embryo. ”

“ Hippocratic medicine, Hippocratic doctrine, Hippocratic oath, are current phrases, and the admonition "Back to Hippocrates" is an admonition to beware of theory and seek the solid ground of observation and experiment.
Between Hippocrates and Galen lie nearly five hundred years without progress in medicine, except as the brilliant Alexandrian school, sheltering Euclid, Archimedes and Ptolemy developed, under Herophilus and Erasistratus, a school of anatomy (ca. 300 B.C.) which established many new anatomical facts. ”

“ THE phrase "Research in Medicine" will naturally arouse different thoughts and associations in the minds of different groups of men.
The bacteriologist will be reminded of Pasteur, Koch, Behring and Flexner and the triumphs of bacteriology and serum-therapy; the surgeon, of Lister and antisepsis, of anesthesia, and of the X-ray ”

“ The intellectual world of Rome, Alexandria and Constantinople was busied with theological controversies. The church became the arbiter of all knowledge and demanded that all science must conform to the Scriptures. Moral and intellectual progress became impossible. ”

“ It is difficult to select a starting point for a systematic survey. Chemistry, however, appears to promise the most direct course, for it was toward the end of the eighteenth century that Lavoisier introduced the modern scientific spirit of exact measurement as applied to chemical phenomena and through it established the great reform responsible for modern chemical knowledge and research. ”

“ In the meantime, however, the practise of medicine labored under great difficulties and was largely a matter of empiricism. Without a knowledge of etiology, without pathological anatomy, that firm foundation for diagnosis, and without a rational therapy it could be nothing else. Mercury, cinchona, cathartics and bleeding were the general methods of treatment. Great and noble men filled the universities-and hospitals ”